Care Management/Medical Social Work - Care Mgmt

PeaceHealth is seeking a Care Management/Medical Social Worker for a part-time, 0.60 FTE, day position. The salary range for this role is $38.22 – $57.34 per hour, with the hiring rate dependent on factors such as education, training, work experience, and applicable collective bargaining agreements.

About the Role

Responsible for identifying and interacting with medically and psychosocially complex patients and families who are likely to benefit from care management and meet high-risk criteria. Coordinates discharge planning services in collaboration with RN Care Management and other members of the care team.

Responsibilities

• Screen and identify patients who need care management per high-risk criteria.
• Assess, develop, implement, and monitor a comprehensive discharge plan of care through an interdisciplinary team process in conjunction with the patient and family.
• Collaborate with the multi-disciplinary team to identify problems or needs requiring special planning, intervention, teaching, or follow-up.
• Identify key problems, strengths, and resources to be addressed in the discharge plan of care.
• Coordinate and facilitate improved compliance with the treatment plan, including counseling or support to cope with the situation and access to appropriate care despite financial or service limitations.
• Actively support measures that promote effective use of resources.
• Identify, plan, and arrange for appropriate services, applying knowledge of community, state, and federal health regulations, as well as admission, discharge, and level-of-care standards.
• Coordinate effective planning and arrange for needed services upon discharge.
• Intervene by arranging services, providing education, and offering psychosocial support to prepare patients and families to manage healthcare needs both in acute care and post-discharge.
• Coordinate with the interdisciplinary team and community resources regarding transitional care management details.
• Consult with physicians as indicated.
• Work with patients identified and referred by RN Care Management, other care team members, or patients/families.
• Conduct evaluations, including appropriate documentation and assessment of Care Management service effectiveness.
• Collaborate with team members to adjust plans if a patient’s health status is not improving.
• May counsel patients and/or families to facilitate participation in community care services, in coordination with the physician and treatment team.
• Work as an integral member of the treatment team in coordinating treatment and transition of care planning.
• Assess and address mental health and chemical dependency conditions.
• May perform risk assessments for suicidality and homicidality.
• Perform other duties as assigned.

Requirements

• Bachelor’s Degree in Social Work or a related field, with a minimum of four additional years' work experience in a medical or healthcare setting, social service agency, or community organization focusing on health and/or welfare issues.
• Master’s Degree in Social Work, Counseling, or a related field.
• Minimum of 2 years of employment in a healthcare setting or community agency dealing with health and/or welfare issues (preferred).
• Basic Life Support certification (required).
• Certified Case Manager (preferred).
• Licensed Clinical Social Worker – Oregon (preferred).

Skills

• Excellent verbal and written communication skills, including sensitivity to other cultures and ethnicities.
• Strong conceptual thinking, listening, problem resolution, and planning skills.
• Demonstrated leadership skills.
• Excellent organizational skills.
• Proficient computer skills, including MS Office applications and electronic medical records.
• Knowledgeable about issues related to chronic illness, developmental disabilities, special needs, mental illness, grief and transition, substance abuse, domestic violence, child abuse, and senior abuse.
• Good understanding and adherence to core social work values and ethics.
• Demonstrated knowledge of community health, welfare, and social agencies.
• Demonstrated knowledge of and ability to apply age-specific principles of growth and development and life stages to meet each patient’s needs.
• Demonstrated proficiency in social work practice.

Working Conditions

• Ability to move around the area with occasional sitting.
• Occasional bending, twisting, reaching, pushing, or pulling.
• Occasional lifting/carrying up to 5 lbs.
• Exposure to biohazards, body fluids, and airborne particles.
• Time spent in medical/hospital settings or office environments.
• Vision and hearing required within normal limits (glasses, contacts, hearing aids permitted).
• Ability to communicate and exchange accurate information.

Benefits

PeaceHealth offers a competitive and comprehensive total rewards package, including:

• Full medical, dental, and vision coverage.
• 403b retirement plan with employer base and matching contributions.
• Paid time off.
• Employer-paid life and disability insurance with additional buy-up coverage options.
• Tuition and continuing education reimbursement.
• Wellness benefits and expanded EAP and mental health programs.